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City of Orono <br /> Building Permit Application <br /> for New Structures or Additions <br /> Mailing Address: Permit number. � �� -C'I c';�c <br /> O�j,�,�.0 PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: / ;� 2� Z <br /> ,� �'e� �" �, Street Address:' ,—, rved-b�. �Z_/_-� <br /> �',�c,t '"� �� 2750 Kefley Parkwa ;� ��� ���:t�� ;Plan review fee: rn�a , � �� <br /> �'kESH��'`� Orono, MN 55356 ' i�' <br /> —.---�. . ___m_�.._..___. �._._.-,____ <br /> Total Fee: <br /> Main: 852-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �,5 �./, Si�/i3i'>'���Y �2�� . <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes �No <br /> If yes,a special event permit is required wrth Police Department and Ciry Council approva160 days prior to fhe event. Shuttle bus service will be <br /> required unless appficanf demonstrates sufficient on-site parking is available. Non-permrtted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: l��=N S � vs� � J-��%M� �w NG�z <br /> State License# Expira ion Date: <br /> Phone: i���,i= �,� �z ,c� �,� y 7�� � (office) (cell) <br /> Mailing Address: - � � -f Cit :M1,�f ;��„�; -�j ZIP: �''� <br /> Contact Person: ��L�yNJ/� �/.��w/� Applicant is: Contractor / omeowne (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INFORMATION: <br /> Name: j�L�/l{ 1 S �-C�'li�J/=' <br /> Phone(daY)� �.'i.Z�-�7.3� 7��3 _�1 <br /> Address: ,�:5 N_ 5Ti/f3i�_� /�3�y /2i.�. CitY� �1����!'L.�i�'I P: ���_'7� <br /> Email and/or Fax f/.t�LGYJ%SNG�./ �'_ LyM/+%L .- G�-�i� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: I7�=N�i S i�f2[i�-1 f� <br /> Phone (day): ���� .�7 ��- � ��� <br /> Address: Z� �,� �r��,�S �,� y� City:,y,qp�c i'G,�,rv ZIP: �.j-j�J <br /> Email and/or Fax: �,y LETi T S�'� � L-3n�/�iL .. c��;vl <br /> PROJECT INFORMATION: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal 8� <br /> Water Supply <br /> ❑ New Construcfion Sin�le_Famil�r�,rith� ❑ Residence (��-L� <br /> �,.Addition Cattached garage�, � Garage/Accessory Bldg. ❑ Public Sewer <br /> ,_, ,. , .. ,.,,, --------- �--- -- -- --___- .— <br /> ❑ Other4(specify) ❑ Multiple Family/Condo ❑Warehouse <br /> ❑ Public ❑ Storage ❑ Public Water <br /> "''Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review&permits. ❑ Industrial � Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 -- <br /> www.minnehahacreek.or <br /> Estimated Construction Valuation (excluding land) $ <br /> Last Updated: 1/26/2011 � ,.� <br /> - �9 - �����v <br /> � <br />